Whorl Pattern and Total Ridge Count on Patient with Essential Hypertension
at Ulin Hospital Banjarmasin
Pola
Whorl
dan Total Jumlah Rigi Sidik Jari Pasien Hipertensi Esensial
di Rumah Sakit Ulin Banjarmasin
Husnul Khatimah1*, Lena Rosida2
1Department of Biology, Faculty of Medicine, Lambung Mangkurat University 2Department of Histology, Faculty of Medicine, Lambung Mangkurat University
*Email: khatynunul@gmail.com
Abstract
Dermatoglypics can used to predicted a disease such as essential hypertension. The aim of this research is to know of summary of whorl pattern and total ridge count on patient with essential hyperten-sion in department of internal medicine of Ulin hospital Banjarmasin period Juli – August 2007. Sample of research from patient with essential hypertension that diagnosed by doctor in department of internal medicine of Ulin hospital Banjarmasin (32 samples), control samples are from normotension person (32 samples). The variables that observed are summary of whorl pattern and total ridge count. The result show that patient with essential hypertension with whorl pattern > 6 is 81,25 %, normotension is 25%. Summary of average of total ridge count in patient with essential hypertension is 147,38, normotension is 129,38. It can be concluded there is difference from patient with whorl pattern > 6 and total ridge count between essential hypertension with control (p<0,05).
Key words: whorl, essential hypertension, ridge skin
Abstrak
Dermatoglifi dapat digunakan untuk memprediksi penyakit seperti hipertensi esensial. Tujuan penelitian ini adalah untuk mengetahui pola sidik jari whorl dan total jumlah rigi sidik jari pada pasien dengan hipertensi esensial di bagian penyakit dalam rumah sakit Ulin Banjarmasin periode Juli – Agustus 2007. Sampel penelitian adalah pasien dengan hipertensi esensial yang didiagnosis oleh dokter di bagian penyaki dalam rumah sakit Ulin Banjarmasin sebanyak 32 sampel, kontrol dari pasien dengan normotensi sebanyak 32. Variabel penelitian adalah pola sidik jari whorl dan total jumlah rigi sidik jari. Hasil penelitian menunjukkan bahwa pasien hipertensi esensial dengan pola whorl > 6 adalah 81,25%, normotensi adalah 25%. Rata-rata jumlah rigi sidik jari pada pasien dengan hipertensi esensial adalah 147,38, normotension adalah 129,38. Disimpulkan bahwa ada perbedaan dari pasien dengan pola whorl > 6 dan total jumlah rigi sidik jari antara hipertensi esensial dengan kontrol (p <0,05).
INTRODUCTION
Dermatoglyphics (finger prints), also known as “epidermal ridge configurations” are the character-istics of the ridged skin on the fingertips, palms, toes and soles of primates (including human be-ings) and some other mammals. They consist of the alignment of the sweat glands’ pores and are shaped in the first trimester of gestation (between the tenth and eighteenth weeks of gestation).1
Dermatoglyphics is one field which gets af-fected by genetic changes as shown in cases of Down syndrome, Schizophrenia, Huntington’s cho-rea and syndactly. The formation of dermal ridges takes place in fetus during 3rd month as a result of physical and topographical growth process. Der-mal ridges and configuration once formed are not affected by age, development and environment changes in post natal life. So it has potential to predict various of genetic and acquired disorders which influenced by genetic factors.2
Essential hypertension is one of the disorders affected by genetic factor. Hypertension is initiated by several combinations of hereditary and environ-mental factors, developing to be an established hy-pertension. Essential hypertension is usually oc-curred in 20-50 year-olds.3 Essential hypertension is regarded as a multifactorial condition such as, the onset and severity of which are influenced by both genetic and environmental factors.The role of genetic factors in the pathology of hypertension is supported by cross-sectional studies that docu-ment familial aggregation of the disorder despite different environmental factors. Twins and adop-tion studies have indicated a greater degreeof trait concordance between identical twins and dizygotic twins and between natural and adoptive siblings
respectively, which also stress the importance of genetic factors.4
Study by Daniela et al. (1991),3 suggested a difference in dermatoglyphic characteristic in teen-agers who suffered from hypertension compared with normal (individual with whorl pattern > 6 of 10 fingers may suffer from hypertension), therefore, dermatoglyphics may be used as a cheaper, easier (non-invasive), and faster predictor of the risk of hypertension.5 Raden suggested that individu with high number of whorl type (> 7) in fingers of both hands, it was predicted that the individu had a ten-dency to have systolic hypertension when he/she was > 40 years old.
A study on the dermatoglyphs of fingertips of essential hypertension patients in Ulin Hospital Banjarmasin has never been done before. There-fore, this study was conducted to provide informa-tion about the dermatoglyphs of essential hyper-tension patients in Ulin Hospital Banjarmasin.
The benefit of this study was to give informa-tion about the dermatoglyphs of the fingertips of essential hypertension patients, so that if they have the dermatoglyphic features of essential hyperten-sion patients, they can maintain their healthy lifestyle to decrease the incidence of hypertension in the future. If essential hypertension is proven to be associated with dermatoglyphics, it can be used as a cheaper, easier (non-invasive,) and faster pre-dictor of the risk of hypertension.
MATERIAL AND METHOD
The method of this research was analytical observational study, with cross-sectional approach. Population of the research was essential hyper-tension patients who visited Internal Medicine Poly-clinic, Ulin Hospital, in July-August 2007. Samples were essential hypertension patients diagnosed by doctors in the Polyclinic of Ulin Hospital Banjar-masin, aged < 50 years old. If the diagnosis of es-sential hypertension was not recorded in medical record, it was established by the following criteria age < 50 years old, systolic BP > 140 mmHg, dias-tolic BP > 90 mmHg, not suffered from renal fail-ure, based on laboratory result in the medical re-cord, not suffered from DM, leprosy, polydactyly, Down syndrome, Turner syndrome, and other inhe-rited diseases.
Thirty-two samples were taken with consecu-tive sampling. Materials and instruments used in this research were paper, plastic cover, scanner Canon Lide, laptop, records of fingerprint pattern, and identity forms which contained the name, age, sex, educational level, and history of diseases/ac-cidents of the samples.
There were independent, dependent, and con-founding vaiables in this research. The indepen-dent variable was essential hypertension patients, and dependent variables were number of whorl
pattern, and ridge count. The confounding variables were the hygiene of the fingers, history of previous diseases, procedure of fingerprinting, overperspi-ration, dirt on the scanner, burns, or genetic dis-eases.
Result data were tabulated and presented in frequency distribution tables, and then the whorl
patterns were analyzed with Chi-square test. Total
ridge counts were analyzed for distribution and homogeneity with Shapiro-Wilk test, which showed that the data were normally distributed and homog-enous (for samples less than 50), and then they were analyzed with t-test with 95% confidence level.
RESULT
A study has been conducted to calculate the dermatoglyphic whorl pattern and ridge count of essential hypertension and non-essential hyperten-sion patients in the Internal Medicine Polyclinic of Ulin Hospital Banjarmasin in July-August 2007. The result is shown in the following Table 1.
Table 1. showed that most (81.25%) essential hypertension patients in Ulin Hospital Banjarmasin in July-August 2007 had whorl pattern > 6 of their ten fingers, while there were only 25% non-essen-tial hypertension patients had whorl pattern > 6.
The difference of the numbers of whorl pat-terns between essential hypertension and non-es-sential hypertension patients was analyzed with Chi-square test. Statistical analysis showed that there was a significant difference (p < 0.05) in the numbers of whorl patterns > 6 between essential
Table 1. Numbers of Whorl Pattern in Essential Hypertension and Non-Essential Hypertension Patients in Ulin Hospital Banjarmasin, July-August 2007
Whorl
pattern
Essential
hypertension Non-essential hypertension
Total % Total %
6 26 81.25 8 25
< 6 6 18.75 24 75
Total 32 100 32 100
Table 2. Average Ridge Counts in Essential Hypertension and Non-Essential Hypertension Patients in Ulin Hospital Banjarmasin, July-August 2007
Left Right Total average
N 64.18 65.2 129.38
HE 74.82 73.3 147.38
hypertension and non-essential hypertension pa-tients, and the odds ratio was calculated. The odds ratio showed that individu with whorl pattern > 6 were 21.598. It means that individu who had whorl
pattern > 6 were 21.59 times more likely to suffer from hypertension in the future, compared with those who had whorl pattern < 6.
Table 2. showed a comparison of ridge counts between essential hypertension and non-essential hypertension patients. Average ridge count of all ten fingers of essential hypertension patients were higher than those of non-essential hypertension patients. This difference was significant (p value < 0.05). Analysis with t-test gave p value = 0.000 (p < 0.05). It can be concluded that there was a signifi-cant difference in ridge counts of essential hyper-tension and non-essential hyperhyper-tension patients.
DISCUSSION
The result of this study (Table 1) was consis-tent with a study conducted by Ramelan (1999)6 who suggested that if there were > 6 of 10 fingers which have whorl patterns, it can be a predictor for hypertension in the future,6 and Raden (2006)3 sug-gested that individual with high number of whorl
type (> 7) in fingers of both hands, it was predicted that the individual had a tendency to have systolic hypertension when he/she was > 40 years old.3
In this study, the average rige count in essen-tial hypertension patients were higher than those
of non-essential hypertension patients. The num-ber of ridges in essential hypertension patients are increased, because there are an increase in whorl
pattern compared with those in non-hypertension patients, because the number of ridges in whorl
pattern is higher than those in loop and arch pat-terns.3
The cause of the difference in fingerprint pat-tern, particularly in whorl pattern, in essential hy-pertension compared to normal person, is not clear. There are considerable factors that may affect the dermatoglyph/ridge count, but the nerves in the epidermis were assumed to have a role.7
Incidence of inherited defects showed a close relationship with particular fingerpattern,3 for ex-ample, mitral valve prolapse was reported to be associated with arch type, essential hypertension was associated with whorl pattern, and abnormal-ity in dermatoglyhic ridges in finger was associated with vascular thrombosis.8
According to Rashad (2007)8, a tendency of
whorl pattern to be associated with hypertension was caused by a proximity and close association of the organogenesis of the hands and cardiovas-cular system, and was controlled completely by genetic mechanism and foetal environment. But the relationship between essential hypertension and
whorl pattern was still not explained clearly.8 Before gestational age of 12 weeks, environ-mental factors may affect the dermatoglyph (ridge
Table 3. The Development of Fingerpattern After Conception8
6-8 weeks after conception Volar pads are developed (similar to the structure of small ball, eleven in one hands, making the contour of foetal hands)
10-12 weeks after conception Volar pads are shrinked
13 weeks after conception Ridge/fingerprint starts to be visible, taking the forms from the shrinkage of volar pads
21 weeks after conception Fingerpattern is completed
count). The environmental factors may be the preg-nant mother’s condition (for example, severe stress), food, drugs, etc. These factors also may affect the development of cardiovascular system, moreover, the development of cardiovascular sys-tem has a close proximity in time with the develop-ment of hands (Table 3).
At the early weeks of pregnancy, all organo-genesis goes through critical phase where heredi-tary and environment factors affect the final result of organogenesis. In the 6-8 weeks, the initial dermatoglyph is developed, in the form of small balls, which are pulled backwards at 10-12 weeks after conception, the finger pattern is visible at 13 weeks and is completed at 21 weeks.8
The fingerprint is not changed from birth until death. Dermatoglyphic patterns between individu-als are never be similar. Variation of dermatoglyphic pattern of a species is different with that of other species, and shows the characteristic of the spe-cies. In human, there are variations of dermato-glyphic patterns between ethnicities. Dermatodermato-glyphic pattern variation is a combination of genetic and pre-natal environmental factors.9 Abnormalities in the growth process, which are liable to distort the align-ment of dermal ridges, may result from the action of abnormal genes, chromosomal aberrations, even from poisoning by a drug, or from a viral infection.10
CONCLUSION
There was a significant relation between both of whorl pattern ridge counts and type of hyperten-sion.
From the result, if the individu has whorl pat-tern more than six, he/she has to change his/her lifestyle, for example, increase the physical activity and reduce salt intake. Since the fingerprint is not
changed from birth until death, it can be used as predictor for hypertension in the future.
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